Morton's Neuroma
NHS Tayside RefGuide
Warning
Who to refer
Refer if no improvement after 3 months of conservative treatment.
How to refer
SCI Gateway/Orthopaedics/Foot and Ankle Service
Referral will be vetted by an AHP and directed to most appropriate professional.
Information to include when referring
- Duration and cause of symptoms.
- Site/spread of pain, constant/intermittent, sleep disturbance.
- Indicate ROM, effect on walking, work/hobbies/sports,
- Include treatment to date (injections).
Symptoms and signs
- Paroxysmal neuralgia affecting web spaces and toes (most common at toes 2,3,4).
- Pain and/ or 'clunk' on Mulder's test (transverse pressure to metatarsal heads whilst palpating the symptomatic inter-metatarsal space).
- Mainly a clinical diagnosis and further investigations are done as indicated.
Initial management
- Provide with patient information leaflet to support self-management.
- Advice re footwear (avoid heels and tight-fitting shoes)
- Analgesia & NSAIDs as appropriate
- Steroid injection if appropriately trained.
Primary Care diagnostics
- Consider arranging an X-ray to exclude other pathology, such as fracture or arthropathy.
- Consider checking full blood count, erythrocyte sedimentation rate, and uric acid to exclude conditions such as osteomyelitis, gout, and inflammatory arthritis.
- Consider Ultrasound scan to confirm diagnosis if necessary.
Useful resources
- Morton's Neuroma (NHS Tayside patient leaflet)
- NICE CKS Morton's Neuroma